Background : Two of the problems of malaria parasite vector control in Nigeria are the diversity of Anopheline vectors and large size of the country. Anopheline distribution and transmission dynamics of malaria were therefore compared between four ecotypes in Nigeria during the rainy season. Methods : Polymerase chain reaction (PCR) was used in molecular identification after morphological identification microscopically. Enzyme linked immunorsorbent assay (ELISA) was used for the blood meal analysis and sporozoite detection. Results : Five species were identified out of 16,410 anophelines collected. An. gambiae s.s made up approximately 29.2%-36.6% of the population in each zone. All five species acted as vectors for P. falciparum . An. gambiae s.s had the highest sporozoite rate. The most infected mosquitoes were found in the rain forest. More blood meals were taken from bovids, except the savannah forest, where 73.3% were on humans and Human Blood index (HBI) was 57.3%. The Entomological inoculation rate (EIR) was a mean of 13.6 ib/p but was highest in the rainforest zone. Conclusions and limitations : This study demonstrates the complex distribution of anophelines and the considerable variations in the intensity of malaria transmission in Nigeria. We highlight the need to consider diverse epidemiological situations when planning countrywide control programmes.

Background : Antimicrobial resistance in Streptococcus pneumoniae has compromised the effectiveness of therapy for pneumococcal diseases and asymptomatic nasopharyngeal carriers play an important role in transmission of resistant strains. Method : Eighty-eight volunteer students attending 2 secondary schools in Jos, Nigeria were involved in this study to determine the antimicrobial resistant profile of Streptococcus pneumoniae isolated from the nasopharynx. The study population consisted of males and females between the ages of 15 - 25 years. Nasopharyngeal swab samples were analyzed for the presence of S. pneumoniae using standard bacteriological methods. The isolates were subjected to antimicrobial susceptibility testing using the disc diffusion method. Results : S. pneumoniae was isolated from 37(42.04%) of the 88 samples. Isolates showed the highest resistance of 12 (32.43%) to erythromycin and lowest resistance of 4(10.81%) to ciprofloxacin. The resistance profiles for the 26(70.27%) penicillin-sensitive and 11(29.72%) penicillin-resistant isolates were similar. Both exhibited varying degrees of resistance to several groups of antimicrobials. However, isolates found to be resistant to penicillin showed a higher degree of resistance to other antimicrobial agents. Conclusion : This study has shown that some secondary school students are carriers of multiple antibiotic-resistant S. pneumoniae .

Background : Stroke, a major cause of morbidity and mortality is on the increase in Nigeria, routine Computerized Tomography (CT) for all Nigerians with stroke is not available to most doctors, and this poses management problems. We compared two available clinical scores with brain CT for the differential diagnosis of cerebral ischemia and hemorrhage among adult Nigerians with first-ever acute stroke. Methods : The study was conducted at the State Specialist Hospital Maiduguri. Ninety-five adult Nigerians presenting with first-ever acute stroke onset within 48 hours were evaluated with the Siriraj Hospital Stroke (SHS) score on presentation and the Guy's Hospital Stroke (GHS) score 24 hours after admission. CT brain scan was considered as gold standard. These two stroke scores were compared with the results of CT brain and sensitivity, specificity; positive predictive and negative values were calculated. Results : Applying the recommended optimum cut-off points for the 2 scores, diagnoses were classified by the Guy's Hospital Stroke and Siriraj Hospital Stroke score as probable hemorrhagic strokes (49% and 25% respectively) and probable ischemic (40% and 65% respectively). The remainder were classified as "uncertain." The prevalence of hemorrhage diagnosed by gold standard (CT) was 29.5% while the prevalence of ischemic stroke diagnosed by CT was 54.7%. The CT brain was normal in 15.8%. Sensitivity, specificity, positive predictive value and negative predictive value for cerebral hemorrhage was 0.64, 0.48, 0.4 and 0.71 for Guy's Hospital Stroke score and 0.35, 0.73, 0.4 and 0.68 for Siriraj Hospital Stroke score. Conclusion : It is evident from the study that these clinical scoring systems alone are not sufficient and one has to employ the use of computerized tomography scan in establishing stroke type in Nigerians with stroke.

Background :Many cases of post-operative and posttraumatic endophthalmitis are being managed at the Khyber Institute of Ophthalmic Medical Sciences, Peshawar in Pakistan but no study has been done to ascertain the magnitude of the disease and to also evaluate the visual outcome after management. Methods : The case notes of 39 patients diagnosed with posttraumatic and postoperative endophthalmitis between May 2006 and April 2007 were analyzed and clinical characteristics obtained were documented and tabulated. Results : During the study period, 2474 patients were admitted in both the male and female wards. Of these, 39 (1.6%) had endophthalmitis due to surgical and traumatic complications. In all, 6 (12.4%) patients had evisceration, while 21 (53.8%) patients who had topical antibiotics consisting of ofloxacin, 0.1% corticosteroids, fortified cetazoline and 1% atropine along with intravitreal antibiotics, a combination of 0.1mg vancomycin and 0.4mg amikacin, were discharged home with a visual acuity of counting fingers to light perception. Conclusion : Endophthalmitis is a serious ocular complication of open globe injury and intraocular surgery. The frequency in this center has been noted to be very high as compared to other places. Its management is very challenging and often leads to devastating structural and functional damage to the eye; causing severe frustration to both the patient and the attending physician. Efforts must be made to prevent the condition.

Background : In an effort to increase tuberculosis (TB) case detection, the Kaduna State TB program in Nigeria started Public-Private Mix (PPM DOTS) in 2002. This study assessed and compared the TB case management practices and treatment outcomes of the public and private health facilities involved in the TB program. Methods : A comparative cross-sectional descriptive study was carried out in 5 private and 10 public health facilities providing TB services for at least two years in the four Local Governments Areas in Kaduna State where both public and private health facilities are involved in the TB program. The heads of the health facilities were interviewed and case notes of all the 492 TB patients registered in these facilities between January 2003 and December 2004 reviewed. Results : Except for the lower use of sputum microscopy for diagnosis, adherence to national TB treatment guidelines was high in both private and public health facilities. The private health facilities significantly saw more TB patients, an average of 51 patients per health facility compared to 23 patients in the public health facilities. There was better completion of records in the public health facilities while patient contact screening was very low in both public and private health facilities, 13.1% and 12.2% respectively. The treatment success rate was higher among patients managed in the private health facilities (83.7%) compared to 78.6% in the public health facilities. Conclusion : Private health facilities adhere to national guidelines had higher TB patient case load and better treatment outcome than public health facilities in Kaduna State. PPM-DOTS should be scaled-up and consolidated.

Background : Teachers are an inseparable corner stone of the society and their satisfaction will affect the quality of service they render. Poor job satisfaction could result in job stress and this could affect their psychological health. This study aims to ascertain the level, causes of job dissatisfaction, intentions to quit and psychological morbidity among teachers in private secondary schools in a developing country. Methods : A cross-sectional study was conducted among teachers (392) in private secondary schools in Benin-City, Edo-State Nigeria, between June 2003 to November 2003. A total population of 400 teachers who had spent at least one year in the service were included in the study. The respondents completed a self - administered designed questionnaire and a standard instrument - The General Health Questionnaire (GHQ 28) Results : The response rate was 98%. Fifty- eight (14.8%) of the respondents had psychological morbidity (GHQ score of 4 and above). One hundred and seventy - eight (45.4%) teachers were very satisfied or satisfied with their jobs. A significant number (45.9%) of teachers would want to quit their jobs. The proportion of teachers with GHQ score 4 and above increased with the level of dissatisfaction but this was not found to be statistically significant. Poor salary was found to be the main cause of job dissatisfaction and major reason for wanting to quit the job. Conclusion : This study shows a low level of job satisfaction among Nigerian teachers. Poor salary was the major cause of job dissatisfaction and intension to quit. Further work need to be done to ascertain the association of psychological morbidity and job dissatisfaction.

Background : Nephrotic syndrome is a common childhood renal disorder; the prevalence of Urinary tract infection (UTI) in these patients is high. The increased prevalence of UTI are due to immunoglobulin loss, defective T cell function, presence of ascites and relative malnutrition. Objective: The study is to evaluate the prevalence of UTI , its etiological agents, antibiotics, sensitivity pattern and the outcome in children with nephrotic syndrome. Methods : A prospective study of all patients with diagnosis of nephrotic syndrome from January 2003 to December 2006. Urine specimen were routinely obtained by clean catch method following careful preparation urethral orifices. The specimens were processed immediately. Five millimeters (5mml) loopful of the sample were inoculated on a blood agar and CLED agar plates. Identification of the organism to species level was by using stokes disc diffusion technique. Results : Forty two patients were studied. The mean age and SEM for males was 8.2 + 0.5years and females with 7.9 + 0.8years. The age range was two to fifteen years UTI was caused predominantly by Staphylococcus aureus in 67.9%, Klebsiella species (17.9%) and Pseudomonas (14.2%). There was high invitro resistance of these organisms to nalidixic acid and ampicillin but sensitive to cefotaxime, ceftriazone and ciprofloxacin. Conclusion : It is recommend that UTI should be sought for in patients with nephrotic syndrome and treatment should be prompt and appropriate.

Background : In order to achieve good results in day surgery and avoid pitfalls, selection of appropriate procedures and patients is required with attention given to the social circumstances among other considerations. The aim of this prospective study therefore was to evaluate the influence of the social circumstances of the patients on the performance of day surgery practice in our environment. Method : This was a prospective study carried out between April, 2004 and December, 2004, during which time 88 children aged 15 years and below with uncomplicated inguinal hernias were treated at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). The parents of the patients were interviewed about their social circumstances to determine the possibility of compliance with postoperative instructions. The data generated were then analyzed. Results : More than half (54.6%) of the patients were from Ile-Ife. A few came from towns varying in distances from 65 to 80 km and spent an average time of 75 to 90 minutes to reach the hospital. Majority of the patients used public vehicles as a means of transport to and from the hospital in escort of their mothers. Despite the long distances and difficult traveling conditions, the parents still preferred day case surgery and were willing to obey postoperative instructions. Conclusion : From the findings in this study, day case surgery in children in our environment is feasible, despite the poor social circumstances of most of them. There is, however a compelling need to raise the standard of living of the people to enable them benefit maximally from day case surgery.

Background : Welders are exposed to a variety of occupational hazards with untoward health effects. However, little is known of welders' awareness of health hazards and their adherence to safety precautions in developing countries. This study assessed the awareness of occupational hazards and adherence to safety measures among welders in Kaduna metropolis in northern Nigeria. Methods : A structured questionnaire was administered on a cross-section of 330 welders in Kaduna metropolis in northern Nigeria. Information was sought on their socio-demographic characteristics, their awareness of occupational hazards and adherence to safety measures. Results : All welders were males with a mean age of 35.7 ± 8.4 years. The illiteracy rate was 7.6%. Overall, 257 (77.9%) of the welders were aware of one or more workplace hazards. This was positively influenced by educational attainment, age, nature of training and work experience. Of the 330 respondents, 282 (85.3%) had experienced one or more work-related accidents in the preceding year. The most common injuries sustained were cut/injuries to the hands and fingers (38.0%), back/waist pain (19%), arc eye injuries/foreign bodies (17.0%), burns (14.0%), hearing impairment (7.0%), fractures (4.0%) and amputation (1.0%). Only 113 (34.2%) welders used one or more types of protective device with eye goggles (60.9%), hand gloves (50.3%) and boots (34.5%) being more frequently used. Regular use of safety device, shorter working hours and increasing experience were protective of occupational accidents. Conclusions : The level of awareness of occupational hazards was high with sub optimal utilization of protective measures against the hazards. There is therefore need for health and safety education of these workers for health and increased productivity.

Background : Type 2 diabetes (T2D) is a major cause of chronic kidney disease. Control of hypertension and the use of angiotensin converting enzyme inhibitors (ACEI) and/or angiotensin II receptor blockers especially in those with proteinuria have been shown to protect against chronic kidney disease and delay its progression to kidney failure. Methods : We reviewed the medical records of 169 patients at 12 months with a view of auditing the screening for chronic kidney disease and the use of renoprotective measures. Results : Urinalysis was done in 49.1% and serum creatinine in 50.3%. No patient had glomerular filtration rate estimated. Seventy nine (67.6%) of the hypertensive patients were on anti-hypertensives. ACEI was used in 49 (45.8%) of these patients BP control was optimal in 29.1%. Conclusion : There is poor adherence to guidelines on chronic kidney disease screening and renoprotection in T2D.

Background : Carcinoma of the breast is an important public health problem in Nigeria and studies have reported low levels of awareness and practice of breast self examination as an important method of prevention. Breast self examination is a cost-effective method of early detection of cancer of the breast especially in resource poor countries. We assessed knowledge and practice of breast-self examination (BSE) among female undergraduate students of Ahmadu Bello University Zaria, Nigeria. Method : In this study, knowledge and practice of BSE were examined among 221 female students aged 16 - 28 years old studying at Ahmadu Bello University Zaria using self administered questionnaires. Results : It was found that despite nearly three quarter of the respondents (87.7%) had heard of BSE, only 19.0% of them were performing this examination monthly. Regarding the sources of information about BSE among respondents, media was found to be most common followed by health workers accounting for 45.5% and 32.2% respectively. Regular performance of BSE was significantly correlated with duration of stay in the University (X² = 81.9, df = 3, P < .05) and family history of breast cancer (X² = 17.4, df = 2, P < .05). Conclusion : We observed a disparity between high levels of knowledge of BSE compared to a low level of practice. Public health education using the media could significantly reduce the knowledge- practice gap and early detection of breast lump.

Female genital fistula is an important feature of the developing countries gynecology. Most of the rectovaginal fistulae encountered in the tropics are due to obstetrics causes and genital malignancies. In developed countries, radiation injury and Crohn's disease are also common etiological factors. The index case is reported to highlight the rare situation, where a 24-year old married nullipara sustained low rectovaginal fistula following normal coitus. She was later divorced by her husband.

Hereditary spherocytosis (HS) is a familial hemolytic disorder with marked heterogeneity of clinical features, ranging from an asymptomatic condition to a fulminant hemolytic anemia. Although a positive family history of spherocytosis increases the risk for this disorder, it may be sporadic in some cases. In severe cases the disorder may be detected in early childhood, but in mild cases it may go unnoticed until later in adult life. A 27-year-old Nigerian woman presented with mild anemia, jaundice, splenomegaly and a history of multiple blood transfusion. Blood film showed about 70% spherocytes, reticulocytosis of 6.5%, increased osmotic fragility test and a negative direct antiglobulin test. She was managed conservatively on nutritional supplements and a significant regression of symptoms after 6 months was achieved.